Transcript Powerpoint: Ch. 16

THIRD EDITION
PSYCHOLOGY
from inquiry to understanding
CHAPTER
16
Psychological and
Biological
Treatments
HELPING PEOPLE CHANGE
Slides prepared by Matthew Isaak
Copyright © 2014, © 2011, © 2009 by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
LO 16.1 Describe who seeks treatment, who
benefits from psychotherapy, and who
practices psychotherapy.
LO 16.2 Distinguish between professionals and
paraprofessionals and describe what it
takes to be an effective therapist.
LO 16.3 Describe the core beliefs and criticisms of
psychodynamic therapies.
LO 16.4 Describe and evaluate the effectiveness of
humanistic therapies.
LO 16.5 List the advantages of group methods.
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Learning Objectives
LO 16.6 Describe the research evidence
concerning the effectiveness of Alcoholics
Anonymous.
LO 16.7 Identify different approaches to treating
the dysfunctional family system.
LO 16.8 Describe the characteristics of behavior
therapy and identify different behavioral
approaches.
LO 16.9 Describe the features of cognitivebehavioral therapies (CBT) and third wave
therapies.
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Learning Objectives
LO 16.10 Evaluate the claim that all
psychotherapies are equally effective.
LO 16.11 Explain how ineffective therapies can
sometimes appear to be effective.
LO 16.12 Recognize different types of drugs and
cautions associated with drug treatment.
LO 16.13 Outline key considerations in drug
treatment.
LO 16.14 Identify misconceptions about biomedical
treatments.
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Lecture Preview
Psychotherapy
Insight therapies
Group therapies
Behavioral and cognitive-behavioral
approaches
• Is psychotherapy effective?
• Biomedical treatments
•
•
•
•
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Psychotherapy
LO 16.1 Describe who seeks treatment, who benefits from psychotherapy, and who practices
psychotherapy.
• A psychological intervention designed
to help people resolve emotional,
behavioral, and interpersonal problems
and improve the quality of their lives
• Over 500 "brands" of psychotherapy
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Who Seeks and Benefits?
LO 16.1 Describe who seeks treatment, who benefits from psychotherapy, and who practices
psychotherapy.
• 20% of Americans have received
psychotherapy at some point in their
lives.
• Females go more than males;
Caucasians more than minority groups
• However, research that shows therapy
can benefit all these groups equally.
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Who Practices Psychotherapy?
LO 16.1 Describe who seeks treatment, who benefits from psychotherapy, and who practices
psychotherapy.
• Clinical psychologists, psychiatrists,
counselors, and social workers are the
mainstays of the mental health
profession.
• But people with non-advanced degrees
also often offer psychological services.
– Social services agencies, crisis
intervention centers
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Paraprofessionals
LO 16.2 Distinguish between professionals and paraprofessionals and describe what it takes to be
an effective therapist.
• Often obtain agency-specific training
and attend workshops that enhance
their education
• Little to no difference in effectiveness
between experienced and novice
therapists
• But, professionals know how to operate
within system and choose more
effective treatments.
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Effective Therapists
LO 16.2 Distinguish between professionals and paraprofessionals and describe what it takes to be
an effective therapist.
Warm and direct
Establish a positive working relationship
Tend not to contradict clients
Select important topics to focus on in
session
• Match treatments to needs of clients
•
•
•
•
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Insight Therapies
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Psychotherapies where the goal is to
expand awareness or insight
• Include psychodynamic and humanistic
therapies
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Psychodynamic Therapy
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Believe that abnormal behaviors stem
from adverse childhood experiences
• Analyze avoided thoughts and feelings;
wishes and fantasies; significant past
events; and the therapeutic
relationship
• Believe that symptoms will vanish when
clients gain insight into unconscious
material
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Psychoanalysis
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Developed by Freud; one of the first
forms of therapy
• Goal is to decrease guilt and frustration
and make the unconscious conscious
• Tries to bring to awareness previously
repressed impulses, conflicts, and
memories
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Psychoanalysis
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Six core techniques:
1.
2.
3.
4.
5.
6.
Free association
Interpretation
Dream analysis
Resistance
Transference
Working through
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The Neo-Freudian Tradition
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• More concerned with conscious aspects
of the client's functioning
• Emphasize the impact of cultural and
interpersonal influences on behavior
• More optimistic; emphasize needs for
power, love, and status (not just sex
and aggression)
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The Neo-Freudian Tradition
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Sullivan's influence on interpersonal
therapy
• Short term treatment (12-16 sessions)
originally developed for depression
• Also effective at treatment of substance
abuse and eating disorders
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Psychodynamic Therapies
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Research, however, shows that insight
is not necessary to relieve distress.
• In addition, many psychodynamic
concepts are difficult to falsify.
• Research shows no evidence for
repressing hurtful memories either.
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Psychodynamic Therapies
LO 16.3 Describe the core beliefs and criticisms of psychodynamic therapies.
• Psychodynamic therapies are
scientifically questionable.
• Still, brief psychodynamic therapy is
better than no treatment, but is less
effective than cognitive-behavioral
therapy.
• Not effective for psychotic disorders
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Humanistic Therapies
LO 16.4 Describe and evaluate the effectiveness of humanistic therapies.
• Therapies that emphasize:
– Development of human potential
– Belief that human nature is basically
positive
• Emphasize importance of taking
responsibility for our lives and living in
the present
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Person-Centered Therapy
LO 16.4 Describe and evaluate the effectiveness of humanistic therapies.
• Developed by Carl Rogers
• Nondirective – encourages clients to
direct the course of their therapy
• To ensure positive outcome, therapist
must:
– Be authentic and genuine
– Express unconditional positive
regard
– Show emphatic understanding
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Person-Centered Therapy
LO 16.4 Describe and evaluate the effectiveness of humanistic therapies.
• Tries to increase awareness and
heightened self-acceptance
• This ideally causes people to:
– Think more realistically
– Become more tolerant of others
– Engage in more adaptive behaviors
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Gestalt Therapy
LO 16.4 Describe and evaluate the effectiveness of humanistic therapies.
• Aims to integrate differing and
sometimes opposing aspects of clients'
personalities into a unified sense of self
• Recognizes the importance of
awareness, acceptance, and expression
of feelings
• Utilizes empty-chair technique
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Humanistic Therapies Evaluated
LO 16.4 Describe and evaluate the effectiveness of humanistic therapies.
• Core concepts are difficult to falsify.
• But, its conditions for effective
therapists have been found to be
related to outcome.
• More effective than no treatment, but
mixed results compared to other
therapies
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Group Therapies
LO 16.5 List the advantages of group methods.
• Refers to therapies that treat more
than one person at a time
• Range from 3-20 people; can be
efficient, time-saving, and less costly
than individual
• Effective for a wide range of problems
and about as helpful as individual
treatments
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Alcoholics Anonymous
LO 16.6 Describe the research evidence concerning the effectiveness of Alcoholics Anonymous.
• Self-help groups like AA have become
very popular and widespread.
• Composed of peers with similar
problems; often no professional
therapists
• Based on "12 Steps" method, but little
research demonstrating its
effectiveness
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AA Alternatives
LO 16.6 Describe the research evidence concerning the effectiveness of Alcoholics Anonymous.
• Controlled drinking programs
encourage people to set limits and
drink moderately.
– Can be effective for many people
• Relapse prevention treatment
assumes people will "slip up" and plans
accordingly.
– Lapse does not equal relapse.
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Family Therapies
LO 16.7 Identify different approaches to treating the dysfunctional family system.
• See most psychological problems as
rooted in a dysfunctional family system
• The "patient" is the whole family
system, not one individual.
• Focus on interactions among family
members
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Family Therapies
LO 16.7 Identify different approaches to treating the dysfunctional family system.
• Strategic family interventions are
designed to remove barriers to effective
communication.
• Structural family therapy has the
therapist immerse herself in the family
to make changes.
• Both are more effective than no
treatment and at least as effective as
individual therapy.
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Behavior Therapy/CBT
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Behavior therapists focus on specific
problem behaviors and the variables
that maintain them.
• Assume that behavior change results
from the application of basic principles
of learning
• Use a wide variety of behavioral
assessment techniques
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Exposure Therapies
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Confronts clients with what they fear
with the goal of reducing the fear
• Earliest was systematic
desensitization, developed by Joseph
Wolpe in 1958
• SD gradually exposes clients to anxiety
producing situations through the use of
imagined scenes.
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Systematic Desensitization
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Based on principle of reciprocal
inhibition - we can't be anxious and
relaxed at the same time
• Uses counterconditioning by
repeatedly pairing an incompatible
relaxation response with anxiety
• Can use imaginal and in vivo exposure
to the fear situations listed on the
created hierarchy
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Systematic Desensitization
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Dismantling research showed that no
single component was essential.
• Led to development of exposure with
response prevention therapies like
flooding
• Very effective for many anxiety
disorders, like phobias, OCD, and PTSD
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Modeling in Therapy
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Participant modeling has the
therapist:
– Model a calm encounter with the client's
feared object or situation
– Guide the client through the steps of the
encounter until she can cope unassisted
• Used in assertion and social skills
training, along with behavioral
rehearsal
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Operant Procedures
LO 16.8 Describe the characteristics of behavior therapy and identify different behavioral
approaches.
• Applied behavior analysis procedures to
treat autistic children
• Token economies reward clients for
desirable behaviors with tokens to
exchange for items.
• Mixed support for the use of aversion
therapies (e.g., Antabuse and alcohol)
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Cognitive-Behavioral Therapies
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• All share three core assumptions:
1. Cognitions are identifiable and
measurable.
2. Cognitions are key in both healthy and
unhealthy psychological functioning.
3. Irrational beliefs or thinking can be
replaced by more rational and adaptive
cognitions.
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Rational Emotive Behavior Therapy
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• Developed by Albert Ellis starting in
1950s
• Emphasizes changing how we think, as
well as how we act
• How we feel about the consequences of
an event is determined by our beliefs or
opinions.
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Figure 16.3 The ABCs of Rational Emotive Behavior Therapy. How someone feels about an event is
determined by his or her beliefs about the event.
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Rational Emotive Behavior Therapy
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• Our vulnerability to psychological
disturbance is a product of the
frequency and strength of our irrational
beliefs.
• To the ABC, Ellis added D (dispute the
beliefs) and E (adopt more effective
ones).
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Other CBT Approaches
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• Aaron Beck developed cognitive
therapy around the same time as Ellis'
REBT.
• Focuses on identifying and then
modifying distorted thoughts and longheld core beliefs
• Works very well for depression; some
evidence of success with bipolar
disorder and schizophrenia
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Third Wave of CBT
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• After behavioral (first) and cognitive
(second), these therapies focus on
acceptance.
• Includes Acceptance and Commitment
Therapy (ACT) and Dialectical Behavior
Therapy
• Highly eclectic; remains to be seen if
these are superior to established CBT
methods
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CBT Evaluated Scientifically
LO 16.9 Describe the features of cognitive-behavioral therapies (CBT) and third wave therapies.
• More effective than no or placebo
treatment
• At least as or more effective than
psychodynamic and humanistic
therapies
• At least as effective as drug therapies
for depression
• In general, CBT and BT are equally
effective for most problems.
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Is Psychotherapy Effective?
LO 16.10 Evaluate the claim that all psychotherapies are equally effective.
• Prior to 1970s, considerable
controversy
• Meta-analysis studies showed that
therapy does work in alleviating human
suffering.
• But which therapy? And for whom?
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Figure 16.4 The Effectiveness of Psychotherapy. This graph shows two normal distributions (see Chapter
2) derived from nearly 500 studies of psychotherapy outcomes. The distribution on the left shows people who
haven't received psychotherapy, and the distribution on the right shows people who have received
psychotherapy. As we can see, across a variety of treatments and samples, 80 percent of people who receive
therapy do better than people who don't. (Based on Smith, Glass, & Miller, 1980)
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Is Psychotherapy Effective?
LO 16.10 Evaluate the claim that all psychotherapies are equally effective.
• Some researchers claim the "dodo bird"
verdict:
– "All have won, and all must have
prizes."
• There are clear exceptions, like BT and
CBT for anxiety disorders and behavior
problems in youth.
• Some therapies may actually be
harmful.
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Some Potentially Harmful Therapies
LO 16.10 Evaluate the claim that all psychotherapies are equally effective.
•
•
•
•
•
Facilitated communication
Scared Straight Programs
Crisis debriefing
DARE programs
Coercive restraint therapies
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Common Factors
LO 16.10 Evaluate the claim that all psychotherapies are equally effective.
• Many therapies may be comparable due
to common factors that cut across
therapies.
• Specific factors are those that
characterize only certain therapies.
• Most agree that both matter, but are
divided over the importance of each.
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Empirically Supported Therapies
LO 16.10 Evaluate the claim that all psychotherapies are equally effective.
• Name for interventions for specific
disorders supported by high-quality
scientific evidence
• Most therapists do not use ESTs in
practice.
• Many BT, CBT, acceptance, and
interpersonal therapies have been
found to be useful.
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Fooled by Ineffective Therapies
LO 16.11 Explain how ineffective therapies can sometimes appear to be effective.
• Five reasons can help explain why
bogus therapies can gain a dedicated
public following:
– Spontaneous remission
– Placebo effect
– Self-serving biases
– Regression to the mean
– Retrospective rewriting of the past
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Biomedical Treatments
LO 16.12 Recognize different types of drugs and cautions associated with drug treatment.
• Attempt to directly alter the brain's
chemistry or physiology to treat
psychological disorders
• Psychopharmacotherapy – use of
medications – is the most widespread.
• Began with use of Thorazine in 1954;
today antidepressants are the most
commonly prescribed medications
among adults.
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Psychopharmacology
LO 16.12 Recognize different types of drugs and cautions associated with drug treatment.
• Today, medications are available to
treat most psychological disorders.
• Antianxiety, antidepressants, mood
stabilizers, antipsychotics,
psychostimulants
• Unfortunately, we don't know exactly
why most of these work.
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Cautions to Consider
LO 16.12 Recognize different types of drugs and cautions associated with drug treatment.
• Not a cure-all, as most meds have
numerous side effects that need to be
weighed
• Most side effects dissipate after
discontinuing the drug, but not all
(tardive dyskinesia).
• Weight, age, and even racial
differences often affect drug response.
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Cautions to Consider
LO 16.12 Recognize different types of drugs and cautions associated with drug treatment.
• Questions about efficacy and safety of
SSRIs in children and adolescents
• Overprescription is also a concern for
many, especially of psychostimulants
for ADHD.
• Polypharmacy is prescribing many
medications at the same; it can be
hazardous.
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Evaluating Psychopharmacotherapy
LO 16.13 Outline key considerations in drug treatment.
• In many cases, therapy alone can
produce as great or better benefits for
many disorders.
• Clear advantages to combining meds
and therapy when:
– Symptoms interfere greatly with
functioning
– Therapy alone hasn't worked for a 2
month period
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Electrical Stimulation
LO 16.14 Identify misconceptions about biomedical treatments.
• Electroconvulsive therapy (ECT)
involves brief electrical pulses to the
brain to produce a seizure.
• Used to treat severe problems
(intractable depression, schizophrenia)
as a last resort
• 6-10 treatments given three times a
week
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Electrical Stimulation
LO 16.14 Identify misconceptions about biomedical treatments.
• Most who undergo ECT would do so
again, and report improvements.
• Must weigh benefits against problems:
– Over 50% relapse in six months
– Short-term confusion and clouded
memory
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Electrical Stimulation
LO 16.14 Identify misconceptions about biomedical treatments.
• Vagus nerve and transcranial magnetic
stimulation are both FDA-approved for
treatment-resistant depression.
• No large-scale studies on effectiveness;
side effects similar to or greater than
ECT
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Psychosurgery
LO 16.14 Identify misconceptions about biomedical treatments.
• Brain surgery to treat psychological
disorders, like prefrontal lobotomies
• Used today as an absolute last resort
with a handful of conditions:
– Severe OCD, depression, bipolar
disorders
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